Basic Information
| Provider Information | |||||||||
| NPI: | 1790736502 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEVEN HILLS SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2010 FLEISCHMANN RD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505520608 | ||||||||
| FaxNumber: | 8505520925 | ||||||||
| Practice Location | |||||||||
| Address1: | 2010 FLEISCHMANN RD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505520608 | ||||||||
| FaxNumber: | 8505520925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | WEAVER | ||||||||
| AuthorizedOfficialFirstName: | TONY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8505520608 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 1240 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 6L6 | 01 | FL | FL BCBS PROVIDER ID | OTHER | 076139700 | 05 | FL | MEDICAID |